(EN13) Dapagliflozin as Once-daily Therapy for Feline Diabetes Mellitus

Abstract: 
Bexagliflozin and velagliflozin, two sodium-glucose cotransporter-2 inhibitors (SGLT2i), are effective in managing feline diabetes mellitus (FDM), but they are not available world-wide. The objective of this retrospective study was to evaluate the use of the SGLT2i dapagliflozin in FDM, either as monotherapy or in combination with insulin. Twenty-seven diabetic cats (20 neutered males, 7 spayed females; mean age 11.9 ± 3.5 years) were included. Twelve cats were newly diagnosed diabetics (ND) and 15 were insulin-treated (IT) for 3 to 96 months (14 received glargine 100 U/mL, 1 received glargine 300 U/mL). Initial dapagliflozin doses were 10 mg q24h (n = 9), 5 mg q24h (n = 13), and 2.5 mg q24h (n = 5). Monitoring included q12h blood glucose (BG), continuous interstitial glucose (IG) measurements (FreeStyleLibre), and beta-hydroxybutyrate (BHB) levels q24h during the first week, and then every 48 to 96 hours. Normoglycemia was defined as BG or IG consistently below 180 mg/dL. Dapagliflozin doses were adjusted according to glycemic response: in cases of hypoglycemia (< 60 mg/dL), the dose was reduced or dosing frequency modified. After 30 days, 92.6% of cats achieved normoglycemia. In the IT group, insulin therapy was reduced (n = 4) or discontinued (n = 11) within 14 days. Dapagliflozin was discontinued in 9 cats: 6 due to remission (ND group), 1 due to severe hypoglycemia (IT group), and 2 due to euglycemic diabetic ketoacidosis (IT group). In the remaining 18 cats, dosing was individualized, ranging from 2.5 mg twice weekly to 5 mg q24h. Follow-up ranged from 3 to 12 months. Clinical signs resolved completely in 25 cats (92.6%) and partially in 2 cats with comorbidities (hypersomatotropism and Cushing’s syndrome). Dapagliflozin appears to be effective as monotherapy in feline diabetes and allowed insulin withdrawal in most cases.